FORMULIR DATA PELAKU USAHA MIKRO KECIL DAN MENENGAH/UMKM

Nama : .....................................................................................................................

NIK : .....................................................................................................................

Alamat : .....................................................................................................................

: Kecamatan...................................................................................................

: Kabupaten Tapanuli Selatan

Nama Usaha : .....................................................................................................................

Jenis Usaha : .....................................................................................................................

Lokasi Tempat Usaha : .....................................................................................................................

Periode Mulai Usaha : .....................................................................................................................

Rekening Bank

Nama Bank : .....................................................................................................................

Nomor Rekening : .....................................................................................................................

Nilai Omzet tiap bulan (Rp) :.....................................................................................................................

Nomor Telepon : .....................................................................................................................

Kelengkapan Berkas:

Fotokopi Kartu Tanda Penduduk (KTP)

Fotokopi Kartu Keluarga (KK)

Fotokopi Buku Rekening Bank sesuai dengan nama Pemilik

Fotokopi Izin Usaha Mikro Kecil (IUMK) atau Surat Domisili Usaha dari Desa/Kelurahan

Foto Produk /Foto Usaha

Pelaku Usaha

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